Study Protocol: Utilization of Cell Phone Applications to Strengthen Malaria Surveillance-Response Systems of Bangka Belitung

The Government of Indonesia (GoI) aims to eliminate Malaria by 2030 in the following stages (Wismarini, 2009): 1. Kepulauan Seribu (DKI Jakarta), Bali & Batam by 2010; 2. Jawa, Nangroe Aceh Darussalam & Kepulauan Riau by 2015; 3. Sumatera, Nusa Tenggara Barat, Kalimantan & Sulawesi by 2020; and, 4. Papua, Papua Barat, Nusa Tenggara Timut, Maluku & Maluku Utara by 2030.

To reach the elimination phase High Case Incidence (HCI) areas go through a pre-elimination phase. The aim of the proposed research is to support one of the Stage 3 provinces in reaching the pre-elimination phase by 2015, and to assist its HCI districts and municipalities in re-orienting their programs to malaria elimination. The pre-elimination phase can be attained by following these evidence-based technical strategies: (1) Prompt & accurate diagnosis of cases; (2) Prompt treatment with effective medicines, including intermittent preventive treatment in pregnancy (IPTp); (3) Selective, targeted & integrated vector control; and, (4) Emergency & epidemic preparedness. (Olumese, 2008).

These strategies can only be properly carried out if the District/Municipal Health Offices (D/M HOs) have a timely, useful and reliable malaria surveillance-response (S-R) system. During the last four years the Center for Health Service Management (CHSM), Gadjah Mada University School of Medicine (CHSM SM), has assisted districts/municipalities in strengthening their MNCH S-R systems. The main activity of this undertaking was training of D/M HO staff in surveillance of cases of priority MNCH diseases with regard to electronic transmission of surveillance data from health centers (HCs) and hospitals, computer processing of surveillance data, and publication of electronic S-R bulletins. The use of computers and electronic telecommunication networks has sped up the flow of institution-based case surveillance data to the D/M HO.

To increase its usefulness, however, the S-R system must include data of cases detected in the community along with data of the disease agent and environment. The proposed project will include the collection of all these surveillance data in order to be useful for the implementation of malaria control strategies. Furthermore, to increase timeliness and reliability, the project will support the malaria S-R systems of the Bangka Belitung Province, Sumatera, by means of Cell Phone (CP) applications through the following activities:

  1. to develop a CP soft-ware for a malaria S-R systems and to set up a malaria S-R central data bank (CDB) that will be placed at a commercial hosting server.
  2. to set up a Village Cell Phone Network in each HCI Village for demographic data and HMM data reporting by households.
  3. to train Village Midwifes or Village Malaria Workers (VM/MW) to provide HMM, to administer IPTp to pregnant members, to send diagnosis, treatment and IPTp data to the CDB, and to obtain blood films for microscopic examination by the HC parasitology microscopist.
  4. to train HC parasitology microscopists to perform microscopic examinations, to use a microscopy-enabled CP for sending microscopy images to the Provincial Lab for reliability testing, and to send data to the CDB.
  5. to train HC co-assistant entomologist, D/M HO assistant entomologist and Provincial HO entomologist to collect vector & environment data, to use a CP for sending vector control targets data to the CDB, and to use a microscopy-enabled CP for sending microscopy images to the Provincial Lab for reliability testing.
  6. to provide consultations, training & resources for the D/MHOs to facilitate the utilization of CP applications for reporting demographic & Home Malaria Management (HMM) data and drug and insecticide resistance/efficacy sentinel surveillance, and to facilitate sector & inter-sector surveillance-based rapid and planned response decision making.

These activities will be carried out in all six districts and one municipality of the Bangka Belitung Province. Reasons for selecting this province: (1) the entire province is an HCI area; (2) high population mobility (migrant workers from Java); (3) a physical environment that is conducive for mosquito breeding (open tin mining and granite quarries); and, (4) the D/MHOs are relatively less supported by projects.

Monitoring & Evaluation of the Project:

Indicators

Monitoring & Evaluation

Impact Indicators: All six districts & one municipality of the Bangka Belitung province reach the pre-elimination phase by 2015. Surveillance of host, agent & vector/environment – distributions according to time, place & population characteristics for monitoring; and, rates for evaluation.
Outcome Indicators:

  1. Rapid & Planned Responses based on surveillance information.
  2. Timeliness, Usefulness & Reliability of Malaria S-R Systems.
 

Monthly assessment of indicatorsTrend analysis of indicators

Output Indicators:

  1. Utilization of the Central Data Bank of malaria S-R systems.
  2. Number of people trained, training/workshops & supervisory visits conducted, equipment & materials distributed.
 

Monthly assessment of indicatorsTrend analysis of indicators

Process Indicators:CP soft-ware development for a Central Data Bank of malaria S-R systems.

  1. Consultations, training & resources for D/MHOs to facilitate:
  2. the utilization of CP applications for reporting demographic & HMM data, for reporting entomological data, and, for drug and insecticide resistance/efficacy sentinel surveillance.
  3. sector & inter-sector surveillance-based rapid and planned response decision making.
 

 

Monitoring of Project Inputs (consultants, trainers, resources) and Processes (consultations, training, coordination, communication)

To ensure attainment of the research objectives the GMU CHSM and collaborating institutions will: (1) obtain endorsements from the heads of the District/Municipal and Provincial Governments; (2) engage MoH Directorate of Malaria and GMU Medical School staff in workshops and technical guidance; (3) engage malaria program managers of the District/Municipal and Provincial HOs as project field coordinators; and, (4) recruit experienced technicians as on-the-job trainers in parasitological microscopy, entomology and information technology and experienced experts as trainers and consultants in public health surveillance and management

References:

Olumese, P. (2008). Malaria control strategies and targets – an overview. Global Malaria Programme, WHO, Geneva.

Wismarini, D.M. (2009). National Malaria Elimination Program in Indonesia. Directorate of Malaria, MoH].

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